Question

Botox injections have been approved by the food and drug administration (fda) as a procedure to treat spasms of the flexor muscles in the elbow, wrist, and fingers. should a payer reject a claim for this use of botox based on lack of medical necessity?

Answer 1

Botox injections comprise Botulinum toxin and is used in the treatment of some kind of eye ailments, like strabismus (crossed eyes) and blepharospasm (involuntary blinking), to treat movement disorders (like torticollis, cervical dystonia) or muscle spasms/stiffness. It can also be used to minimize the cosmetic appearances of wrinkles.

However, due to certain side effects, the drug was ban by FDA, but it has been approved by the FDA for treating spasms of the flexor muscles. Although, there is a scenario that the claim for the application of the drug could be rejected in case of a lack of a medical necessity, that is if it does not fulfil the usual accepted professional medical standards of care.